Assessment of the ICDDR,B [International Centre for Diarrhoeal Disease Research, Bangladesh]-based maternal and child health - family planning (MCH-FP) extension project : Bangladesh

Interim evaluation covers the period 1989-1992 and includes recommendations for the SP's third and final 5-year funding phase (1992-97). The SP, which is being implemented by the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) and the Population Council, has had a major impact in testing and introducing programmatic interventions for improving the national FP program. These interventions, conducted in collaboration with the Government of Bangladesh (GOB) have included: recruitment of additional community-based field workers, improved implementation of satellite clinics, an improved client-based service statistics system, and home delivery of injectable contraceptives. The SP has also drawn considerable attention to the success of the national FP program through extensive publication of scientific articles and through foreign visitors. The SP's future potential is unquestioned and continued funding is highly recommended. Specific findings on SP research, intervention, and dissemination activities include the following. (1) Though SP research designs are sound and findings have been useful, the research agenda has been heavily biased in favor of data from ICDDR,B's Matlab site, rather than the SP's own two field sites, and the research has been largely quantitative in nature. (2) While many SP interventions that have been tested and replicated have significant implications for increased program costs, few have focused on, or directly tested, possible cost-saving activities such as the use of volunteers, depot holders, and improved method mix. In the next phase, cost aspects should be a major factor in selecting and prioritizing proposed interventions. Also, activities have been focused at the thana level or below, and as a result, cost-effectiveness and replicability remain to be demonstrated, More attention should be given to developing support among higher levels of the GOB and to coordination with other GOB and NGO activities. (3) In-country dissemination of information about SP activities has been less than ideal and will require more attention; proposed activities include the exploration of alternative means of communication such as briefing meetings, workshops, and translation of SP information into Bangla. Some shortcomings are also evident with respect to the SP's structure and management. The SP has not been guided by a strategic plan, and research and intervention agendas have often been based on the interests of individual staff. The SP's management structure has fluctuated to fit these agendas, creating confusion among staff. Also, while the SP has funded considerable long- and short-term training, staff who have been trained have not been moved into higher positions; the rationale for long-term training during the next phase is questionable. Finally, the proposed merger of the MCH-FP Extension and Urban Volunteers projects under a single cooperative agreement with ICDDR,B needs further consideration and planning before implementation.